This document provides an introduction to midwifery and obstetrical nursing. It discusses the historical development of midwifery from ancient times through the modern era. It also covers topics such as the roles of nurses in midwifery, preconception care, national policies on maternal health, and maternal and infant mortality rates. Technological advances, ethics, and contemporary perspectives in obstetrics are also addressed.

1. INTRODUCTION TO MIDWIFERY AND
OBSTETRICAL NURSING
BY:
MS. LAMNUNNEM HAOKIP
SENIOR TUTOR
OBG NURSING DEPT.
SSNSR

2. • Historical review of Obstetrics
• Development of midwifery in India
• Trends in midwifery and obstetrical nursing
• Legal and Ethical Aspects
• Role of nurse in Midwifery
• Preconception care and preparing for parenthood
• National Policy and Legislation in Relation to Maternal Health and Welfare
• Maternal Morbidity, Mortality rates, Perinatal Morbidity and Mortality Rate

3. Obstetrics word came from a Latin word “OBSTETRIX” means
“MIDWIFE”.
Midwifery, also known as obstetrics, is a health science and health profession
that deals with pregnancy, childbirth and the postpartum period (including care
of newborn), besides sexual and reproductive health of women throughout their
lives.

4. Midwifery is the knowledge necessary to perform the duties of midwife.
Obstetrics is that branch of medicine, which deals with the management
of pregnancy, labour and puerperium.
Gynecology is that branch of medical science, which treats disease of the
female genital/ reproductive organs.
Reproduction means process by which a fully developed offspring of its
kind is produced.
Pregnancy is a state of carrying fetus inside the uterus by a woman from
conception to birth.

5. Gestation means pregnancy.
Gravida is a state of pregnancy irrespective of its duration.
Multipara refers to woman who has given birth more than once.
Nullipara is the woman who has not given birth before.
Primigravida is a woman carrying first pregnancy.
Multigravida is a woman carrying pregnancy more than once.

6. HISTORICAL REVIEW OF OBSTETRICS

7. MIDWIFERY DURING THE STONE AGES (40,000 – 2000 BC)
Woman learnt to support themselves during childbirth based on their
knowledge and skills gained by observing other mammals while giving
birth.
Their concept of labour was adopting a squatting position, cutting the
umbilical cord, initiating breastfeeding and creating a safe environment for
the new-born.
During these periods, conduction of delivery involves- clean environment,
providing psychological support and proper new-born care.

8. MIDWIFERY IN ANCIENT TIMES – BIBLICAL ERA ( 2200 BC –
1700 BC)
During this era, midwifery was a valued social practice performed by
women of childbearing age.
The midwives were skilled in performing the procedures.
Birthing stool was introduced in this era.
Family centred care was introduced as one of the vital approaches of
professionalism in midwifery.

10. MIDWIFERY DURING EGYPTIAN ERA (3500 – 100 BC)
The Egyptian midwife were more competent in the clinical area in
determining the EDD, different types of delivery chair and having more
knowledge to accelerate the delivery progress as compared to other
midwives of those era.
Also competent in prescribing herbs as drugs during labour and they were
aware of its pharmaceutical agents.
Woman of low socio economic status were not birthed during this era.

11. GRECO ROMAN ERA ( 500 BC – AD 400)
The Greek civilization shaped midwifery as an art and a scientific
profession.
The ancient practice were based on the religion and faith.
Midwives were ranked into two category: Consultant midwives and
Herbalist Midwives.
Male physician were supposed to intervene in breech presentation
pregnancies or cases that required internal operations.

12. MODERN ERA ( NINETEENTH CENTURY ONWARDS)
British Nurses Association was established in 1887 in UK to regulate the
scope of nursing and midwifery based on systemic medical education and
training programmes.
The Midwifery Act was accepted in 1952 and Central Midwives Board was
established to regulate midwife registrations.
Main focus was promoting public hygiene, providing prenatal care, home
visits.

14. MIDWIFERY IN INDIA BEFORE INDEPENDENCE
The indigenous village dais were the key persons to perform delivery by
helping the woman during child birth and also act as a consultant.
First training school for dais was established in 1877 by Miss Hewlett, an
English Missionary.
1926, Madras Registration of Nurses and Midwives Act was passed to
promote role of registered midwives for service during childbirth.
1936, midwifery training started as a separate course in India.

15. MIDWIFERY IN INDEPENDENT INDIA
In 1946, the Bhore committee laid stress on the need for qualified
midwives, health visitors and the training of dais.
In 1955, the Shetty Committee recommended the training of Auxiliary
Nurse Midwife (ANMs) in health centers for maternal and child health
services, provided there were adequate health visitors to supervise them.
In 1959 Bishoff, a technical Consultant supported the training of two types
of nursing personnel ANM and General Nurse Midwife (GNM Nursing – 3
years and Midwifery – 1 year).

16. In 1947, the first step the Indian Nursing Council took after its inception
was to combine the nursing and the midwifery courses into a single course.
The course was designed to be of three and a half years duration, with the
entry qualification being 10th class.
In 1975 the Kartar Singh Committee recommended shortening the two year
course of ANM to one and a half years and entry after class 10th.
These ANMs were designed as female health workers. They were specially
trained in midwifery and child health care services.
Government of India also invested heavily in the training of dais.

17. The trained nurse midwife (RN, RM): Who has undergone a diploma
(Diploma in General Nursing and Midwifery), which is of three and a half
years duration. A degree nurse who has done B.Sc. (Honors) Nursing, which
is of four years duration.
The ANM, who is designated as the Multi – purpose health worker
(female), is registered as a midwife.
Skilled Birth Attendant (SBA) refers exclusively to people with
midwifery skills (e.g. doctors, nurses, midwives) who have been trained to
get proficiency in the skills necessary to manage normal deliveries

19. TECHNOLOGICALADVANCES
As the technology has revolutionized, it has made dependency on computer
in today’s world and requires nurses to become skilled in the use of modern
technology.
Because of this advancement, the ‘hands-on-care’ is reduced, so also the
quality nursing care.
For Example: Fetoscope is replaced by electric fetal monitoring.

21. INCREASED COST OF HIGH-TECH CARE
Sophisticated technologies being introduced does effect the cost of
treatments. Procedures like – USG, does cost good amount of money.
CHANGING PATTERNS OF CHILDBIRTH
Due to increased in numbers of working women, there is a high chance of
complications during pregnancy.

22. FAMILY CENTRED-CARE MATERNITY CARE
Nurses plays an instrumental role in caring of the mother and the family in
aiding with labour process and also providing a homelike environment and
participate in childbirth experiences.
RISING CAESAREAN BIRTH RATE
With the used of high-end technology, the rate of caesarean births has
increased.

23. EXPANDED ROLES FOR NURSES
Increasing nursing responsibility for assessment and professional
judgement and providing expanded roles for nurse practitioners, such as the
nurse – midwife.
ACCESS TO HEALTH CARE
Strong predictors of access to quality health care include having health
insurance, a higher income level and a regular primary care provider or
other source of ongoing health care.
Use of clinical preventive services, such as early prenatal care, can serve as
indicators of access to quality health care services.

24. SHORTENING HOSPITAL STAYS
Routine hospital stay for mothers and newborns after an uncomplicated
birth is now 2 days or less.
Short term hospital stays require intensive health teaching by the nursing
staff and follow up by home care or community health nurses.
INCREASED USE OF ALTERNATIVE TREATMENT MODALITIES
There is a growing tendency to consult alternative forms of therapy, such as
acupuncture or therapeutic touch.

25. CONTEMPORARY PERSPECTIVE OF OBSTETRICS
In current view all the focus from obstetrics care shifted to perinatal care,
Advancement in Obstetrics care has reduces the MMR. Govt. has started
programme to identify high risk mothers. Training of health personnel's,
Allocation of facilities & equipment decreases MMR.

26. MMR can be reduces:
Early registration of pregnancy.
At least three antenatal check-ups.
Dietary supplements can correct anemia.
Prevention of infection and hemorrhage during puerperium.
Prevention of complications e.g. Eclampsia, Malpresentation, ruptured
uterus.
Treatment of medical conditions e.g. hypertension, DM, TB.
Anti-malaria and tetanus prophylaxis.

28. Clean delivery practice.
Institutional deliveries for women with Bad Obstetric History and risk
factors.
Promotion of family planning.
MCH services has started which aims at reduction in morbidity and
mortality rate of mother and baby.
Baby friendly hospital scheme has launched in 1993 for effective breastfeed
to child.
Genetic counselling to the couples.
Screen the mother for HIV.

30. ETHICAL DECISIONS IN REPRODUCTIVE HEALTH OF WOMEN
Gynaecologic practice
Beneficence-based and autonomy-based clinical judgements in
gynaecologic practice are usually practice in situations like ruptured ectopic
pregnancy and practice to determine which management strategies protect
and promote the patient’s interest.
Obstetric practice
Provide basis for obligations and works towards it.

31. Assisted Reproductive Techniques
Involves like – IVF, egg sharing, freezing and storing of embryos research
and surrogacy.
If proper formalities not performed there can be problems arising.
Ultrasonography
Issues like- competence and referral, disclosure, confidentiality and routine
screening.
Genetics
Confidentiality should be maintain for genetic testing and result should be
not disclosed with anyone except the patient.

33. Pre-counselling is a meeting with health care professional by the couple
attempting to become pregnant.
AIMS
Helping a couple to achieve pregnancy.
Decreasing the risk of a pregnancy loss
Decreasing the chance of birth defects
Improving health
Identifying medical conditions.

34. COMPONENTS
Nutrition
Folic Acid Supplement: 0.4mg daily starting from 1 – 3 months
prior to planned conception.
Exercise
Medical condition: DM, HTN, Epilepsy
Genetic Counselling
Immunization

35. Caffeine
Lifestyle changes
Illicit drugs
Medications
Occupational exposures
Domestic violence

36. Preparation
Physical Preparation
Age>18 years for girls
Genetic Counselling
Stop oral contraceptive pills
Free from infection
No exposure to hazardous substances
Balanced diet
No violence

37. Psychological preparation
Plan for maternity leave
Be ready to meet increasing demands
Financial preparation
Prepare for institutionalized care during pregnancy and delivery
Prepare for care of the newborn

38. Benefits
Healthy conception and children
Successful and long-term breastfeeding
Low risk of postpartum depression
Reduced risk of abortion, premature birth, abnormally
Preparation for family

40. National population policy
Address the unmet needs for basic reproductive and child health services,
supplies and infrastructure.
Reduce infant and maternal mortality.
Achieve universal immunization of children against all vaccine preventable
diseases.
Promote delayed marriage for girls, not earlier than 18 and preferably after
20 years of age.
Achieve 80% institutional deliveries and 100% deliveries by trained
persons.

41. Achieve universal access to information/ counselling and services for
fertility regulation and contraception with wide basket of choices.
Contain the spread of AIDS and promote greater integration between the
management of reproductive tract infections and sexually transmitted
infections and the National AIDS control organization.
Integrate Indian System of Medicine in the provision of reproductive and
child health services and in reaching out to households.
Promote vigorously the small family norm to achieve replacement levels of
TFR.

42.  Legislation
The medical termination of pregnancy act – 1971, Conditions under which
pregnancy can be terminated.
Persons who can perform such terminations (Registered Medical
practitioner).
The place where such termination can be performed (institution approved
for the purpose).
Dais were unwilling to trained and patients will to accept the old customary
methods. In 1926 Midwives Registration Act formed for the purpose of
better training of midwives.

44. Maternal morbidity describes any short- or long-term health problems that result
from being pregnant and giving birth.
Maternal mortality refers to the death of a woman from complications of
pregnancy or childbirth that occur during the pregnancy or within 6 weeks after
the pregnancy ends.
Perinatal mortality is defined as the number of fetal deaths past 22 (or 28)
completed weeks of pregnancy plus the number of deaths among live-born
children up to 7 completed days of life, per 1000 total births (live births and
stillbirths).
Perinatal morbidity is defined as any short-long term illness or health problems
of newborns/infant that result from preterm delivery and placental perfusion.

45. There are various reasons for the death of women during their reproductive
age (18 to 39 years) that had been the cause of an increase in the maternal
mortality and morbidity rate. Given below are a few reasons for the rate of
deaths of women due to pregnancy and childbirth:
Spread of diseases
Unawareness
Lack of nutrition and unhealthy livelihood
Hemorrhage
Incorrect Treatment

47. ANAEMIA MUKT BHARAT (AMB)
Anaemia Mukt Bharat (AMB) strategy was launched in 2018 with the
objective of reducing anaemia prevalence among children, adolescents
and women in the reproductive age group.
It focusses on six target beneficiary groups, through six interventions
and six institutional mechanisms to achieve the envisaged target under
the POSHAN Abhiyan.

49. SURAKSHIT MATRATVAASHWASAN (SUMAN):
The Surakshit Matritva Aashwasan (SUMAN) has been launched by
the Ministry of Health and Family Welfare in 2019.
It aims to provide assured, dignified and respectful delivery of
quality healthcare services at no cost and zero tolerance for denial
of services to any woman and newborn visiting a public health facility
in order to end all preventable maternal and newborn deaths and
morbidities and provide a positive birthing experience.

50. Under the scheme, all pregnant women, newborns and mothers up to
6 months of delivery will be able to avail of several free health care
services such as four antenatal check-ups and six home-based
newborn care visits.

51. PRADHAN MANTRI MATRU VANDANA YOJANA (PMMVY)
Pradhan Mantri Matru Vandana Yojana (PMMVY) is implemented by
the Ministry of Women and Child Development.
PMMKVY came into effect from 1st January 2017.
This Maternity Benefit Program is implemented in all districts.
On fulfilling certain conditions, the beneficiaries would receive Rs
5,000 in 3 installments.

52. Cash benefits would be directly transferred to the bank accounts of the
beneficiaries.
Pradhan Mantri Matru Vandana Yojana – Common Application
Software (PMMVY – CAS) is used for monitoring this program.
Maternal mortality ratio = (Number of maternal deaths / Number of
live births) X 100,000
The Perinatal mortality rate is calculated as: (Number of perinatal
deaths / total number of births (still births + live births)) x 1000.

53. Communicator
Manager
Record Keeper Advisor
Supervisor
Educator
Family Planner
Counselor
Leader
Care Giver

55. BIBLIOGRAPHY & REFERENCE
• Annamma Jacob, A comprehensive textbook of Midwifery and Gynecological
Nursing. Fourth edition, Jaypee Brothers. pp 789-801.
• Park K, Essentials of Community Health Nursing, 4th Edition, Banarasidas
Bhanot Publisher, Jabalpur. pp 234-250.
• Kumari Neelam, Essentials of Community Health Nursing, 1st Edition, PV
books jalandhar. pp 260-274.
• https://www.goodreturns.in/classroom/2018/02/7-indian-government-
schemes-women-empowerment-680804.html
• https://www.yourarticlelibrary.com/women/women-welfare-programmes-
in-india/47647